In March 2021, a new vision for clinical research was released, Saving and Improving Lives: The Future of Clinical Research Delivery in the UK, which sets out the ambition to create a clinical research environment centered on patient-friendly, innovation-friendly and data-driven. This vision, supported by all nations of the UK, aims to empower health service workers to help carry out research and enable people across the country to participate in clinical research.
Heart disease is the leading cause of death in Scotland, and although over the past decade morbidity rates have fallen by 24%, it remains the number one problem facing Scots today. So how can research help tackle this pressing health burden and improve the lives of patients not just in Scotland, but around the world?
Professor Lis Neubeck became the head of the Cardiovascular Clinical Network at NHS Research Scotland (NRS) a month after the vision was published, overseeing all cardiovascular trials in Scotland.
Getting back to pre-Covid scale trials has been a slow process.
However, as Scotland continues to recover from the pandemic, the NRS Cardiovascular Research Network is keener than ever to draw attention to patients and seek to encourage more healthcare professionals to engage in cardiovascular research in order to achieve better health outcomes in the future.
Holyrood spoke to Professor Neubeck about heart disease in Scotland and his vision for the future of cardiovascular research.
Speaking about Scotland and heart disease over the past decade, Professor Neubeck said: ‘We have a dubious reputation for having one of the highest rates of cardiovascular disease.
“Over the last decade or two we’ve seen a decline, but over the last four or five years it’s leveled off and we haven’t made any further progress.
“I think we need an investment in cardiovascular research and cardiovascular prevention and management, to continue to realize those gains that were so visible through public health actions, such as a reduction in smoking and improvements in medicine and medical treatment.
“Things like angioplasty and stenting have made a huge difference, at least for morbidity.
“We really should be looking at ways to reduce cardiovascular disease through a combined mechanism and that’s really the goal of the cardiovascular disease action plan.
“We need to team up and work in partnership with other departments that may have similar research interests.
“In addition to that, we need to think about other determinants of health, like the environment, the built environment, pollution levels, socio-demographic differences.”
Professor Neubeck explained how research can improve under the new vision and achieve better health outcomes. “We need to understand how we recruit people from diverse backgrounds.
“One of the traditions of research is that we mostly do research on healthier people, so it’s very difficult to engage people from diverse backgrounds.
“Many studies recruit more men than women.
“I think equality is a huge issue around access to research right now and giving people the opportunity to participate, who may not necessarily understand that it’s an option for them.
“In terms of research and practice, they have to work much more closely together, that has to be a priority.
“We would like to see research move much faster to clinical trials than it has traditionally.
“As the Cardiovascular Network in Scotland, we are particularly interested in dissemination and implementation, how these things evolve and how can we work better with our clinical colleagues to achieve this.”
The short-term focus of NRS cardiovascular research will be centered on patients and learning what they need.
Neubeck highlighted its importance and one of the ways they plan to do this. She said: “Heart Day on May 3 is a day dedicated to patients.
“What we do is bring together a range of different people to discuss what the priorities should be and how to move them forward.
“For me, if we’re not including the voice of the patient, we’re not including the most important voice in all the work we do.
“It’s something that is close to our hearts.
“Patients at NHS sites who are clinically active are given different opportunities.
“They could benefit from increased attention as they have more visits to the site.
“They might get a treatment that might be beneficial, that’s the thing with a trial, you don’t know if you’re going to get the active treatment or how the treatment is going to work.
“You will likely get further investigations which may provide you with new opportunities to take care of your health as a result of the trial.
“They are more likely to get very constructive support and information.”
Professor Neubeck made a point of emphasizing that the constructive support and information provided to patients benefits healthcare professionals involved in research and is not reserved for cardiologists.
She believes it is of paramount importance to encourage and empower more nurses, midwives and allied health professionals to take on research responsibilities.
Professor Neubeck said: ‘I think it’s an untapped resource, or not yet well tapped.
“Traditionally, in cardiovascular research, these are led by cardiologists and we have capacity problems if we only allow certain people to carry out studies, because eventually our principal investigators will not be able to do anything else. .
“We need to think about building capacity in research leadership and to me, logically, it seems that nurses, allied health professionals and midwives are a largely untapped resource.
“We have to allow them to do that, and it might not be a role expectation yet, but it can be.
“Being able to answer questions through research is a real joy.
“As a nurse myself, I found it exciting to be able to do studies and show what happens when we implement something.
“There also needs to be a built-in way of rewarding people for taking on these additional roles.
“That needs to be recognized in our promotions framework and how we can support people and give them the advantage of being part of those roles.”
Professor Neubeck spoke about the difficulty during the pandemic in undertaking research and her hopes for the future.
She said, “I’ve been in the role for just under a year and we’re still in the recovery phase.
“Hopefully this will accelerate as we move out of the acute Covid research phase, allowing us to do more of our different types of research.
“I think there are a lot of things we learned from Covid.
“We had a very traditional model of trials, where we have phases that happen sequentially, and we can start thinking about how these can be done in parallel or how we could use the main ones.
“This is particularly relevant for digital health, if we wait to test the digital tool while we follow this traditional model, we will not put it into practice until the technology is already outdated.”
The future of technology in cardiology research is vitally important, according to Professor Neubeck, and it is something she has studied for more than a decade.
She said, “I started getting into digital health around 2009, and at that point we didn’t have any apps.
“Now we have so many potential apps, the growth is staggering, but since this was organic growth, we haven’t ranked them well and are unable to tell which apps work for which individual. .
“We can do a lot better with registrations and linkages, using all kinds of different data.
“We have one of the best systems to potentially link data in Scotland, but now it’s not done in real time.
“This real-time data analysis would be extremely beneficial.
“Connecting all these different systems that help us understand the influence on health systems such as prescription data, mortality data, hospital admission data.
“There are of course opportunities for diagnostic tools that we need to understand how we are going to use them sustainably, while being careful not to create a kind of digital divide, because not everyone has access to the same equipment. .
“We need to be very aware that when we move towards digital transformation, we are not creating and increasing access gaps.”
What is clear is that clinical research plays a vital role in improving health care for all. The acceleration of treatments and vaccines during the pandemic, combined with a host of new technologies and treatments – artificial intelligence (AI), genomics, data – has the potential to be transformational.
Clinical research is the key to realizing the promise and potential of this new era of healthcare. Advancing new treatments, technologies and techniques, and integrating them across the NHS, will bring benefits to patients and their families, and help improve the health of our entire population.
This article is sponsored by NHS Research.